Don’t Discount Alpha Blockers for Large Ureteral Stones

Providers want to help their patients pass kidney stones without surgery. A new review shows alpha blockers are still a good bet, especially for large stones.

7:00 AM

Author | Haley Otman

A collection of large kidney stones

Providers are always looking for the right combination of lowest risk and highest benefit for their patients.

MORE FROM THE LAB: Subscribe to our weekly newsletter

For patients with kidney stones that won't pass on their own, contemporary practice guidelines recommend considering alpha blockers to facilitate stone passage.

But when a 2015 study questioned the effectiveness of alpha blockers for this purpose, many physicians wondered whether to change course.

John Hollingsworth, M.D., associate professor of urology at the University of Michigan Medical School, served as first author on a new review of 55 pieces of kidney stone research that investigated the effect of alpha blockers. The review suggests physicians should feel confident following current guidelines.

"We found alpha blockers do work for larger kidney stones," Hollingsworth says. "It's a win for our patients to have nonsurgical help to pass their kidney stones."

He explains more about the significance of the work, published this month in The BMJ.

What was different about your research approach?

Hollingsworth: The popular recent article suggested it may not be worth the time or money to try alpha blockers for kidney stone patients. Their multicenter study in the U.K. compared alpha blockers to placebo in 1,136 subjects and did not find the alpha blockers effective.

There had been a fair amount of ambiguity following the U.K. trial. So we thought it was important to take those findings and put them into the context of what is already known about kidney stones.

Our team pooled together 55 randomized controlled trials, all comparing alpha blockers to placebo or control. With this approach, we were able to evaluate 5,990 subjects all at once and get a full picture of the situation.

We also considered stone size and location to see if either one was a factor in successfully passing the stone.

What did your review find?

Hollingsworth: Overall, the results show moderate evidence to support using alpha blockers for those kidney stone patients who do not require urgent surgery.

SEE ALSO: A Step Toward a Vaccine Against Urinary Tract Infections

We reported a 57 percent higher risk of stone passage for larger stones when the patient was taking an alpha blocker. However, the benefit was not there for smaller stones. The location of the stone did not make a difference, nor did the type of alpha blocker used.

In addition to a shorter time to pass the stone, patients who used alpha blockers also reported fewer pain episodes and a lower risk of hospital admission, and they were less likely to undergo surgery.

What should providers take away from this?

Hollingsworth: Our review helps solidify the current guidelines, which recommend off-label use of alpha blockers, such as tamsulosin, known as Flomax, for kidney stones. Providers can now better identify the patients who are likely to benefit from alpha blockers: those with larger kidney stones.

It's great news that patients dealing with intense pain from kidney stones may indeed find relief with a medication rather than a surgery.

More Articles About: Rounds Urology Kidney Stones Kidney Disease
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories person in phone and people looking
Health Lab
Despite social media claims, Borax is not safe to consume
A Michigan Medicine explains a dangerous TikTok trend about Borax
gloved hand doing microplate samples
Health Lab
Study brings insight to kidney cancer with gene mutation
A study from clinicians and researchers at the University of Michigan Rogel Cancer Center reveals findings from over 800 clinical assays performed for kidney patients with MiTF family gene mutations.
sperm purple glowing
Health Lab
Modifications to amino acids in sperm could be behind infertility
Researchers at the University of Michigan are now delving into the molecular-level details of sperm formation, with a particular focus on how abnormalities in this process might lead to male-factor infertility.
kidneys blue yellow
Health Lab
Research analyzes kidney functions and predictors of disease
The research describes the creation of a cellular atlas of the kidney describing nearly 100 cell types and states. It represents the most comprehensive study of cellular states, neighborhoods, and outcome-associated signatures in the kidney.
Doctors Surgeons Heart Surgery Operation
Health Lab
Researchers discover new opportunities for preventing kidney injury following cardiac surgery
Researchers discover new opportunities for preventing kidney injury following cardiac surgery.
kidney black white and pink and blue lines
Health Lab
How disparities in kidney care happen, and what to do about it
The risks of not getting the proper kidney care when it’s needed are high – and unfortunately, not everyone can access the care they need.